Healthcare Insurance

Claim

Healthcare Insurance

Client visiting doctor and collecting document

Client submit claim document to claim handling unit (TPA)

TPA sends notification on claim receiving (to sufficient docs) or notification on additional document requirement (to insufficient docs)

TPA handles the claim and sends notification of claim solution (to the claim under coverage) or notification of claim declination (to the claim out of coverage)

TPA transfers reimbursed amount to the bank account registered in claim form

Client feedback if disagree to claim result. TPA discusses to client, in case of adjusting claim solution, TPA will rehandles and transfers additionally.

Required claim document

Medical document:
- Medical report, prescription
- Indication and result of tests and/or imaging
- Discharge form (in case of hospitalization)
- Certificate of surgery (in case of surgery operation)
Payment document:
- Converted e-invoice
- Breakdown
Other document:
- Accident report (in case of normal and daily accident)
- Report of traffic accident (in case of traffic accident)
- Report of labour accident (in case of labour accident)
- Certificate of Death (in case of death)
- Certificate of inheritance right and Authorization of insurance beneficiary (in case of death)
Documents:
- Claim form
- List of direct billing. This is the short list and for reference only. Please contact us for full version.